Research Summary: Patients' Perspective of Home Exercise Programs and the use of healthSwapp

University of Toronto Research Summary

What was the purpose of this study?

This study explored the experiences and
perspectives of physiotherapy outpatients with
respect to their home exercise programs (HEPs)
and how the use of healthSwapp affected the
integration of HEPs into daily life.

Why was this study important?

Physiotherapists regularly prescribe home
exercise programs (HEPs) to facilitate the
management of musculoskeletal injuries and
conditions. Adherence levels to physiotherapy
HEPs are reportedly low in outpatient practice. In
physiotherapy, there are novel mobile applications
that are arising with the objective of enhancing
patient engagement in HEPs. However, the patient
perceptions of these new tools remains
unexplored.

What were the methods

Ten outpatient physiotherapy patients participated
in this study. All patients received treatment at the
same physiotherapy clinic from two
physiotherapists. A qualitative descriptive study
design was used. Semi structured individual face-
to face interviews were conducted with each
participant.

What were the results?

Results revealed three themes that support one
main finding:

The development and modification
of a customized home exercise program (HEP) is
a process that requires ongoing collaboration and
negotiation between the patient and
physiotherapist.

Collaboration and Negotiation: Therapeutic
Alliance

Early establishment of a therapeutic alliance
created a foundation for building an ongoing
collaborative and iterative approach to the
participants’ physiotherapy treatment.

Participants expressed appreciation for
receiving education from the physiotherapist
regarding the purpose of the HEP that was
tailored to their individual knowledge and
learning style.

Ongoing negotiation and two-way
communication between the patient and
physiotherapist helped ensure that the HEP
continued to fit within the context of each
individual’s life, and that any necessary
modifications were made.

“I’m glad that she’s modified my exercises to what my actual experience of them is. And if it’s something I don’t like to do ... she’ll cut it out and replace it with something else instead.” – Melissa

Customization: Exploring the Mediators of
Adherence

Consideration of unique features of
participants’ daily lives and preferences was
critical to co-creating a HEP.

Three primary contextual features that
mediated whether a patient completed their
exercises or not were: time, environment, and
exercise complexity.

1. Time: developing a routine, by setting aside
specific times of day to complete exercises
helped patients become more consistent with
their HEP. However, unplanned interruptions
to the routine was a commonly discussed
barrier to adherence.

2. Environment: The factors that contributed to
whether or not HEP were done in the
workplace dependedon the nature of the
exercises, the work environment, the nature of
the work, and the individual. Some
participants were fearful of possible judgment from their co-workers, whereas others welcomed their co-workers to join them.

3. Complexity: The need for equipment and/or a
particular set-up acted as a barrier for some
participants.

Mediators of adherence were complex in
nature, and uniquely influenced individuals
based on the context of their daily lives

To render the greatest benefit, application
features should be personalized to fit each
patient’s lifestyle and preferences

A mobile application can serve as an effective
adjunct and extension of physiotherapy
treatment, however it does not replace crucial
elements of the in-person interaction.

healthSwapp: Patients’ Experiences of Using a Mobile Application

Participants were positive about their experiences with healthSwapp and noted that they preferred the application’s visual format to paper based handouts due to its accessibility and practicality.

healthSwapp can enhance the integration of a co-created customized HEP into a patient’s daily life. HealthSwapp acted as a valuable tool for augmenting but not replacing the patient therapist encounter.

"I do find the videos very helpful ... I’ll want a refresher on it even though it has been shown to me in person and I have done it a few times ... making sure I’m getting the proper technique ... is very valuable” – Claire

Key Analysis Findings

The development of a therapeutic alliance was imperative for collaboration and negotiation to occur; this approach involved the patients’ perspective in the creation and modification of a customized HEP

Mediators of adherence were complex in
nature, and uniquely influenced individuals
based on the context of their daily lives

To render the greatest benefit, application
features should be personalized to fit each
patient’s lifestyle and preferences

A mobile application can serve as an effective
adjunct and extension of physiotherapy
treatment, however it does not replace crucial
elements of the in-person interaction.

Implications for Practice

From our findings we recommend
physiotherapists dedicate ample time to asking
patients questions and getting a detailed
account of their daily lives in order to foster a
collaborative approach to exercise prescription.

We suggest the physiotherapist frequently
follows up to understand how patients are
managing to incorporate their HEP within
their lives, and remains open to making any
necessary modifications.

Future Directions

Determine how to best implement technology
into physiotherapy practice to enhance
completion of HEPs

To explore the perspectives and experiences
of physiotherapists implementing technology
into their practice.